The president of the High Court has expressed concern that a doctor with "sub-standard medical knowledge" who mistook an ankle for an elbow in an X-ray could have been employed in three different hospitals.
Mr Justice Peter Kelly rejected an appeal by Dr Omar Hassan Khalafalla Mohamed (30) against being struck off the medical register for professional misconduct and poor professional performance.
The Irish Medical Council (IMC) had recommended the erasure of Dr Hassan's name from the register.
It made the recommendation after a Fitness to Practice Committee found him guilty on multiple grounds related to his conduct and performance.
The incidents occurred at the Midland Regional Hospital Portlaoise, Mayo General, and Galway University Hospital between 2012 and 2014.
On one occasion, while performing a gall bladder procedure, Dr Hassan stood on the pedal of an electrosurgical machine, which was not in use, and caused a burn injury to a patient.
On another occasion, Dr Hassan, originally from Sudan, tried to insert a needle into a patient's arm, causing her pain, even though the procedure was not necessary.
In February 2014, during a trauma meeting/teaching session in Galway, he misidentified an X-ray image of an ankle as being one of an elbow.
He was also found by colleagues to act in a bizarre way and to be aggressive and confrontational to colleagues and patients.
The court previously heard Dr Hassan had complained about his treatment at the public inquiry and threatened it "will be fully paid for at an extremely bloody price for the people involved worldwide".
He also wrote there would be "a grave response from me and my family side to these events outside court and not necessarily in Ireland".
Mr Justice Kelly, on that occasion, said he was glad to know the IMC had informed gardai of the threats.